Vol 3 Issue 1 April 2015-September 2015

Abstract: Antenatal care is a preventive obstetric health care program aimed at optimizing maternal fetal outcome through regular monitoring of pregnancy [55]. Even if WHO recommends a minimum of four ANC visits for normal pregnancy, existing evidence from developing countries including Ethiopia indicates there are few women who utilize it due to different reasons. 1127 pregnant women from EDHS of 2011 were used to analyze the determinants of the barriers in number of antenatal care service visits among pregnant women in rural Ethiopia. The data were found to have excess zeros (51.5%); the variance, 7.196, is much higher than its mean, 1.85.Thus several count models such as Poisson, NB, ZIP, ZINB, HP, and HNB regression models were fitted to select the model which best fits the data. Each  of  these  models  was  compared using SAS version 9.2 by their likelihood  ratio  test  (LR), Voung test  and the  information criteria’s. Through the analysis, access to modern ANC visits during pregnancy was low in rural Ethiopia than the national value. Lack of awareness, absence of education, heavy workload, poverty, and shortage of health post were significantly associated with not attending ANC visits. Hurdle Poisson regression model was found to be  better  fitted  with  data  which  is  characterized  by  excess  zeros  and  high variability in the non-zero outcomes.

Keywords: ANC; Hurdle; NB; Poisson; Zero-Inflated.

Title: Modeling the Number of Antenatal Care Service Visits Among Pregnant Women in Rural Ethiopia: Zero Inflated and Hurdle Model Specifications

Author: Dawit Sekata

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: This summer I had the opportunity to intern at the Washington DC Veterans Affairs Medical Center observing physicians and cardiologists treat patients in real time. This experience has confirmed my desire to pursue medical school in the future. However, I know doctors work in a flawed healthcare system which has led me to research more about the medical field starting with the pharmaceutical industry. Beyond science, the more I researched; the politics and business aspects of medicine have stunned me. The profit-hungry pharmaceutical companies also known as “Big Pharma” have misguided the public regarding new drugs which have little to no health benefits. After reviewing medical journals, analyzing both quantitative and qualitative data, several researchers have consistently concluded that there is a lack of checks and balances between drug companies and governing authorities. The battle to secure unbiased, ethical drug developments has grown into one of the greatest controversies in American history. The profits are far too immense that the federal government has compromised its strict standards at the hands of drug merchants. Today, 4.5 million consumers visit their doctors regarding adverse prescription drug side effects due to false drug trials. Doctors are lured to prescribe one drug over another through gifts and vacations that affect their prescribing habits. For nearly a century, the pharmaceutical company’s goal has been to reduce costs and earn profits rather than to provide life-saving and life enhancing medicine for patients. This paper aims to offer solutions to the problem at hand through policy modifications regarding drug trials and direct physician marketing.

Keywords: pharmaceutical companies, Big Pharma, Checks and Balances in the Pharmaceutical Industry.

Title: Tackling Big Pharma: Checks and Balances in the Pharmaceutical Industry

Author: Seung Hwan Baek

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Specific memory defects and brain function abnormalities are linked to sleep deprivation-a major issue that many experience daily. For instance, inadequate sleep impairs the hippocampus, the major brain structure that is responsible in learning and memory formation. Studies found that there is a great link between sleep and academic performance and that sleep deprivation has a negative influence in academic performance and learning. Receiving enough sleep does not only help the brain to function properly, but also has a positive impact on our lifespan and is imperative in maintaining a good health.

Keywords: Deprivation, Sleep Impairs, Sleep Deprivation, Negative Influence.

Title: Sleep Deprivation and Brain Function: How does sleep deprivation effects college students’ ability to retain information and create memories?

Author: Mayow, Abshiro

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Most women are not able to develop adequate iron stores during growth period. Thus women enter pregnancy state with depleted iron stores. This is a prospective Randomized controlled study conducted on women in the 2nd & early 3rd trimester of pregnancy with iron deficiency anaemia The mean age group in this study is 22.9+3.7 yrs, 43.33% of them were primigravida’s & 56.7% of them were multigravida’s.  In iron Sorbitol group the mean rise in Hb% was by 0.8+0.17gm% at 4wks & 1.72+0.5gm% at delivery. Mean reticulocyte count by 0.46+0.14% & mean hematocrit rise was by 3.5+2.3% at 4wks & by 4.1+2.2% at delivery. In iron Sucrose group the rise in mean Hb% was by 2.2+0.4gm% at 4wks & by 3.04+0.5 gm% at delivery.  Mean reticulocyte count by 0.46+0.15% & increase in mean hematocrit was 6.2+2.2% at 4wks & 6.9+2.9% at delivery. In group A the mean rise in ferritin level was 72.6+10.5 5ug/l & in Group B it was 31.6+5.2ug/l.  In cases of iron Sorbitol 13.33% of the cases had severe reactions amounting to stop the injections & 60% had mild to moderate reactions continuing the injections. None of them developed severe reactions in Group A to stop the injections. The rise in parameters is statistically significant in both groups. Even though Iron Sorbtol is as efficacious as Iron sucrose in raising the Hb level, the Occurrence of more number of reactions restricts its use for intramuscular use. Iron Sucrose can be used as Observed Therapy ensuring definitive iron replenishment.

Keywords: Anaemia, Iron Sucrose, Parenteral Iron.

Title: A Comparative Study- Efficacy and Safety of Intravenous Iron Sucrose & Intramuscular Iron Sorbitol in Iron Deficiency Anemia during Pregnancies in Low Socio Economic Status

Author: Kadri Yogesh Bangera, Sujay Heranjal, Chethan K

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: This is a review article on the problems of menopause. The menopause is caused by a fall in the amount of the hormone oestrogen produced by the ovaries. Menopause is a time of transition, the end of the fertile years and an individual experience for every woman. Menopause is when the ovaries stop releasing eggs and menstruation ends for good. As a woman approaches menopause, her ovaries gradually makes less and less of the hormones. Many women notice emotional highs and lows. many other physical and mental changes that can occur in midlife, which again reflect changes in both the physical environment (i.e. hormonal changes) and changes in your personal life (e.g. caregiving stress). Pre menopause means "around menopause" and refers to the time period during which a woman's body makes its natural transition toward permanent infertility (menopause). Main symptoms associated with menopause were reported as fatigue, hot flashes, Cold sweats, and backaches. Other ailments associated with menopause were arthritis, hypertension, and diabetes. Menopause is a natural event and cannot be prevented. Diet, exercise and lifestyle changes can reduce the symptoms and complications of menopause. A healthy balanced diet with regular meals, as irregular eating can make certain symptoms worse, such as feeling tired, when it comes to a healthy diet, balance is vital. This means consume the right amount of food and drink to achieve and maintain a healthy body weight during menopause.

Keywords: Menopause, Pre menopause, Weight gain, Healthy eating.

Title: Effect of Menopause on Women’s Health, its Symptoms, Treatment and Dietary Modification to over Come This Problem

Author: Miss Shaifali Pathak

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Infection with Herpes Simplex Virus Type-2 (HSV-2) is the primary cause of genital herpes and the most common cause of genital ulcer disease (GUD) worldwide. The aim of this study is to assess the seroprevalence of HSV-2 infections among HIV infected adults attending antiretroviral clinic in Specialist Hospital Sokoto; and to verify the association between HSV-2 infection and HIV-status, age, level of education and positive history of painful genital ulcers.   Specimens (blood sample) were collected from one hundred (100 )volunteers attending Antiretroviral Clinic in Specialist Hospital Sokoto and tested for HSV-2 antibodies using a one-step cassette style HSV-II IgG which work based on the principle of immunoassay combined with conjugated colloid gold technology. Data were analyzed using SPSS version 18.0. P values ≤ 0.05 were considered significant.  Out of the 100 individuals tested, 17 (17.0%) were HSV-2 positive. Infected individuals were more likely to be female than male (12% versus 5%; P > 0.05). There were high rates of infection in all age groups, and the prevalence increased with age. However, multivariate logistic regression analysis showed that HSV-2 prevalence was significantly associated with occupation, educational status, and number of sex partners and sexual behaviors (P > 0.05) and not significant with age, marital status, tribe, religion, p>0.05.The results highlight the potential public health impact of HSV-2 in Nigeria where anti-HSV-2 testing is not generally done in all populations.

Keywords: Herpes Simplex Virus, HIV, HSV-2, Specialist Hospital Sokoto.

Title: The Seroprevalence of Herpes Simplex Virus2 among HIV infected adults attending antiretroviral clinic in Specialist Hospital Sokoto, Nigeria

Author: Saidu, A.Y., Munir G., Mustapha U. K., Abubakar B. U.

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: The present study focuses on the musculoskeletal problems faced by the washroom cleaners working in malls of Mumbai City. Cleaning activities are considered to be physically demanding and should be done without exposing workers to the risks of accidental injury or work-related ill health. Numerous investigations have shown, however, that cleaners are at risk of developing MSDs of the back, neck, shoulders, elbows, hands and lower limbs as a result of their work [1].

Here, an attempt has been made to study and assess the job activities and work related musculoskeletal problems and other postural problems especially among the women workers working as housekeepers/cleaners in the Malls of Mumbai City. For the study a sample of 30 housekeepers was selected from 5 similar types of malls (based on size and the number of the visitors). An Interview Schedule was developed based on the observations and the pilot study in the malls OWAS technique was used to assess the various postures adopted at work using photographic technique. The activities performed by housekeepers were cleaning floor, walls, commodes, sinks, and mirrors and throwing the sanitary waste. The finding of the study revealed that 53.3% and 26.6% females felt that the overall job to be very heavy and heavy respectively. Whereas 46.6% and 30% females perceived throwing sanitary waste and commode cleaning to be heavy tasks respectively. It was also seen that all these activities were repeated minimum for at least 5 – 7 times and sometimes 8 – 10 times daily by the housekeepers thus leading to excessive bodily pain and discomfort due to repetitive movements involved. Almost all the women workers reported of having pain in neck, shoulder, wrist, low back and knee. But in terms of intensity of pain, the workers had very severe pain in Low back (96.7%), wrist (76.7%) and shoulder (70%), followed by upper back (60%) and neck (53.3%) region. The overall job was rated as very heavy. Activities like cleaning platform, sink and commode were rated as heavy activities. Similarly the postural analysis by OWAS technique put these activities into action category – 3 where corrective measures were needed as soon as possible. Thus, confirming to the result of RPE rating as heavy activities for cleaning platform, sink and commode. The study proposes to recommend of having training programs for maintaining right posture at work, use of ergonomically designed equipment’s for cleaning, regular medical check-ups and to have exercise regime for workers and finally to the designers of the washroom in the malls to design keeping in mind the stress it is going to put on the cleaners while cleaning and not just aesthetics.

Keywords: Housekeepers, cleaning, posture, washroom cleaners. MSD, OWAS.

Title: Work Related Musculoskeletal Problems Faced By the Washroom Cleaners Working In Malls

Author: Dr. Manjit Kaur Chauhan, Ms. Priyanka Patel

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract:  hospitalization can be disturbing experience for young children because of their lack of self-esteem, their dependence on others and limited experience with the medical system. This study was conducted to evaluate the effectiveness of therapeutic play in preparing child for hospitalization in order to reduce the impact of hospital anxiety on their behavior. The investigator conducted study among 60 hospitalized pre-schoolers of selected paediatric hospitals in Coimbatore district, Tamilnadu, India. Convenience sampling technique was adopted to divide the study participants into study and control group and the physiological parameters, preschool anxiety was assessed using tool designed by the investigator. The result of the study indicate that therapeutic play can be a effective means of hospital preparation in order to prevent negative impact of hospital anxiety on pre-schoolers.

Keywords: therapeutic play, pre-schoolers, hospital preparation program, anxiety.

Title: Effectiveness of Therapeutic Play for the Hospital Preparation Program among Preschoolers

Author: Mary Usha .X

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: A controversy exists among health care providers on the choices of safe and successful drugs for pregnant women as painkillers. Also the choice of safe and successful drugs in general pain management in pre-hospital settings.

I searched on the Wiley Online Library, the Science Direct Database, the Pro Quest Database, Springer Link, Expanded Academic ASAP, and the ECU Library Database (from Jan 2006 to Sep 2014) to identify all relevant randomised controlled trials of pain management during pregnancy and general pain management in pre-hospital settings. Critically appraise four different articles on the safety of intravenous fentanyl for hospital pain management in pregnant patients and inhaled methoxyflurane for general pain management in pre-hospital settings.

There was an obvious shortage of studies on intranasal fentanyl for pre-hospital pain management in pregnant patients; it also has been noticed that they are limited of latest studies on inhaled methoxyflurane as pain management in pregnant women. Based on the literature, using IV fentanyl as a pain relief during labour in nulliparous and multi-pregnancy women has been proven to be safe and effective for both the women and neonates. Based on the findings, methoxyflurane was the most common opioid analgesia agent used by paramedics. Overall, methoxyflurane appear to be safe drug as pain management in pre-hospital setting for all group of age.

Acceding to the literature, IV fentanyl, as a analgesia in nulliparous and multi-pregnancy women during labour has been proven to be safe and effective for both the women and neonates. Finally, methoxyflurane has been proven to be to be a safe drug for pain management in pre-hospital settings for all age groups.

Keywords: intravenous fentanyl, pain management, pregnant patients, inhaled methoxyflurane, pre-hospital pain management.

Title: The Safety of Intravenous Fentanyl for Hospital Pain Management in Pregnant Patients and Inhaled Methoxyflurane for General Pain Management in Pre-Hospital Settings

Author: Rayan Jafnan Alharbi

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Although blood ordering is a common practice in surgical field, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence based estimates. Over-ordering with minimal utilization squanders technical time, reagent and imposes extra expenses on patients. The purpose of this study was to determine the efficiency of blood utilization for elective and emergency surgery at Ndola Central Hospital with a view of establishing a Maximum Surgical Blood Order Schedule (MSBOS).

Methods:  Laboratory-based retrospective descriptive study was conducted at Ndola Central hospital. Data for elective and emergency surgeries were collected from all discharged surgical patients and blood bank registries. Blood utilization was calculated using crossmatch to transfusion ratio (C/T), transfusion probability (%T), and transfusion index (TI) indices.

Results: During the study period, the transfusion department was requested to prepare 2,300 units of blood for 2,100 patients.  Of these, 810 units were transfused for 400 patients. Blood transfusion from the units crossmatched was 35.2%. The overall ratios of C/T, %T, and TI index were 2.8, 20.0%, and 0.40, respectively. These blood utilization indices showed a different value between each department. In department of surgery, for instance, overall C/T ratio was 2.8 with high ratio in elective than emergency (4.1 versus 1.9). In addition, the overall %T was 14.5% with 20.9% in emergency and 9.7% in elective patients. On the other hand, in department of gynecology and obstetrics, the overall C/T ratio was 2.8 with elective surgical patients having the highest C/T ratio (4.3) than emergency patients (1.6). Moreover, the overall %T and TI were 26.1% and 0.38, respectively.

Conclusions: The overall blood utilization was not encouraging and excessive crossmatching with minimal transfusion practice was observed in elective surgical patients. However, for emergency surgical procedures blood utilization was within the acceptable limits. Therefore, blood ordering pattern for elective procedures need to be revised and over-ordering of blood should be minimized. Moreover, the hospital with blood transfusion committee should formulate maximum surgical blood ordering policies for elective surgical procedures and conduct regular auditing.

Keywords: Blood Requisition, elective surgery, MSBOS, Transfusion Index, cossmatch.

Title: Analysis of Blood Cross-match ordering practice in surgical patients at Ndola Central Hospital

Author: Alick Mwambungu, Nathan Siulapwa, Duncan Mugala, Mwamba Chishimba

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Raising community awareness towards more healthy daily practices undoubtedly is very noble. Definitely, there is mounting increase in in the number of Automated Teller Machines (ATMs) users in Al-Ahsa, KSA. Unfortunately, there is a misleading sense of security among users of that machine, being unaware of the fact that germs are everywhere! To address this, this descriptive comparative study aimed to characterize the bacterial load, if any that is harboring the keypads and touch screens of the ATMs and compared its type(s) and susceptibility to those harboring the flush buttons of the toilets that was randomly selected from different regions of Al-Ahsa. The research team addressed a still viable question: Why hand-sanitizers are only available in the outpatient clinics of health care facilities to deliver antimicrobial protection for health care providers?  Is not ATMs more worthy of the presence of such hand-sanitizers? The unexpected results of this study will certainly shed some light for care providers fighting communicable diseases that cost the Saudi economy millions of Riyals annually.

Keywords: Automated Teller Machines, Hand sanitization, environmental screening & communicable diseases.

Title: At Your Fingertips, Get Money and More: The Story of Acquired Teller Microorganisms

Author: Khaled Zahran, Hussein Al-Naghmoush, Daham Al-Shemri, Aly Alfuridan, AbdelRahman AlKadhy

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Leprosy is a chronic infectious disease involving skin and peripheral nerves. It is present in different clinico-pathological forms depending upon immune status of the host. This study has been conducted to know the correlation between clinical and histopathological diagnosis of leprosy. This was a retrospective study conducted in department of Dermatology of tertiary care centre. All patients visiting to Dermatology out patient department during the period of January 2013 to May 2015 were enrolled in the study in whom leprosy was clinically diagnosed or suspected. Clinical and histopathological findings were retrieved from the records and analyzed. A total of 112 patients were studied, of them 64 (57.1%) patients were males and 48 (42.9%) females. Clinically borderline tuberculoid (BT) was diagnosed in 32 (28.5%), tuberculoid (TT) in 4 (3.5%), lepromatous (LL) in 8 (7.1%), borderline lepromatous (BL) in 4 (3.5%), indeterminate in 2 (1.7%) and relapse in 2 (1.7%) patients. Out of 112, type of leprosy could not be specified in 52 (46.4%) and in 8 patients classical clinical features were not noted, so Hansen’s disease was kept as a differential diagnosis. On histopathological evaluation, epidermal changes were noted in 31.2% and dermal changes were following; granuloma (41.2%), dermal infiltrate (12.5%), adnexal infiltrate (8.1%), nerve infiltrate (10.7%), adnexal with nerve infiltrate (6.2%), perivascular with adnexal infiltrate (19.6%) and nonspecific (1.7%). Predominant dermal lympho-histioctytic infiltrates were seen in 50 percent of the cases. Borderline tuberculoid and tuberculoid was the most common histo-pathological diagnosis among patients with 28% and 48% respectively, followed by Indeterminate 16%, LL and BL 2.6% each. When clinical and histopathological diagnosis was correlated it was found that the parity was noted in TT, BT and LL were 66.6%, 56.2 % and 12.5% respectively. Three patients had leprosy out of 8, in which Hansen’s disease was kept as a differential diagnosis. The study being retrospective the uniformity in clinical diagnosis and histopathological evaluation could not be assessed. With the limitations this study still give information about the importance of histopathology to diagnose Leprosy and for proper treatment.

Keywords: Leprosy, Histopathology, Ridley-Jopling.

Title: CLINICAL AND HISTOPATHOLOGICAL CORRELATION IN LEPROSY: A TERTIARY CARE HOSPITAL BASED STUDY

Author: Dr. Veeresh. Dyavannanavar, Dr. Satish. Belagatti, Dr. Shashikant

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Chronic Kidney Disease (CKD) is associated with high incidence of morbidity and mortality. The imbalance between oxidants and antioxidants is thought to play an important role in the tissue damage in CRF. The objective is to evaluate oxidant and antioxidant imbalance in CRF patients

Methods: A total number of 80 subjects comprising of 40 healthy controls and 40 Chronic Kidney Disease patients attending dialysis unit before dialysis were studied. In all the subjects, serum levels of malondialdehyde (MDA) as a biomarker of lipid peroxidation and antioxidant whole blood reduced glutathione (GSH) were estimated.

Results: The level of whole blood reduced glutathione was significantly decreased in CKD Patients when compared to healthy controls. Serum MDA was significantly increased in CKD patients when compared to controls.

Conclusion: The presence of increased systemic oxidative stress in chronic kidney disease patients seems to be associated with accumulation of uremic toxins, increased gycation end products and increased homocysteine level. The decrease in antioxidants levels appears to be mainly a consequence of increased oxidative stress. This suggests that oxidative stress is likely to be involved in the tissue damage in CKD patients.

Keywords: Oxidative stress, Antioxidants, CKD, Whole blood reduced glutathione, MDA.

Title: Study of serum Malondialdehyde and Whole Blood Reduced Glutathione in Chronic Kidney Disease

Author: Satishkumar D, Nagaraj R S, V Vishali

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: Transfusion-transmitted infections [Human immune deficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), syphilis and malaria] acquired through the therapeutic blood transfusion process is a most important universal health problem in transfusion medicine. WHO, FDA and Indian government have selected mandatory testing criteria for each unit of blood in India. Design: Study was carried out over a period of 5 year i.e. 2009 to 2013. The conducted study was prospective and retrospective. The testing protocol was followed in the blood bank, after complete physical examination of blood donor by blood bank medical officer. Results: Over a five year period total blood donation was 10641, in which 9679 (90.39%) were replacement and remaining 962 (9.61%) were voluntary. There was a rise in number of voluntary donor over the five year period. The prevalence of HIV, HBsAg, HCV, Syphilis and Malaria was 11 (0.10%), 92 (0.86%), 129 (1.21%), 26 (0.24%) and 11 (0.10%) respectively. The seropositivity of HCV showed increasing trend from 2009 to 2013. The decreasing trends of prevalence were seen in HIV, Syphilis and Malaria. Conclusion: These findings propose that pre-donation counseling and donor self-exclusion will be effective in decreasing the TTI’s as well as practices of autologus blood transfusion should be encouraged. Nucleic acid amplification testing (NAT) must be implemented that identify blood donation made during the immunological window period before seroconversion.

Keywords: HIV-Human Immunodeficiency Virus, HBSAg-Hepatitis B Surface Antigen, HCV-Hepatitis C Virus, VDRL-Vineral Disease research Laboratory, WHO-World Health Organization.

Title: Prevalence of Transfusion Transmitted Infection among Blood Donors in Tertiary Care Hospital

Author: Yogesh Kumar. Monika Garg, Sushant Kumar Meinia

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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Abstract: The number of medication errors associated with preventable deaths in healthcare facilities remains at a high rate for healthcare leaders. Practices of medication delivery remain similar to those 10 years ago. Hospitals that have implemented barcoding medication administration systems have reported a decrease in medication errors ranging from 60% to as high as 93%. Despite this utility of barcoding, only 50% of U.S. hospitals have implemented barcode medication administration. This comparative case study explored the strategies hospital leaders used to implement barcode medication administration systems, utilizing the sociotechnical theory for a conceptual framework. Face-to-face, semi structured interviews were used to identify experiences from a purposive sample of 20 hospital leaders from Minnesota and Iowa. The research question guiding this study addressed strategies hospital leaders used to implement barcode medication systems to reduce preventable medical errors. After analyzing the interview transcripts using inductive analyses, 4 themes emerged. These themes include the strategic organizational communication, technology and end user support, hands-on training, and application of audit reports. Hospital leaders might benefit from the study findings when developing strategies to implement barcode medication systems. The implication for positive social change includes the potential of decreasing patient medication errors and reducing loss of life caused by medication errors with hospital leaders accelerating the adoption of barcode medication systems in hospitals. Other health care providers may explore how the findings might help reduce medication errors in their facilities.

Keywords: Barcode, Medication, Safety, Implementation, Qualitative, Sociotechnical Theory.

Title: Strategies for Implementing Barcode Administration Systems

Author: Julie Ann Frederick, Dr. Cheryl McMahan

International Journal of Healthcare Sciences

ISSN 2348-5728 (Online)

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